膝动脉栓塞治疗膝骨关节炎：永久性与临时性栓塞剂系统评价与荟萃分析
该系统评价与荟萃分析纳入22项研究共633例患者719个膝关节，评估膝动脉栓塞术治疗症状性膝骨关节炎的安全性与疼痛结局。结果显示12个月VAS疼痛评分组内加权均数差为-39.6 mm（95%CI -47.1至-32.1），但三项假手术对照RCT的组间差异无统计学意义（SMD -0.23，95%CI -0.71至+0.25，P=0.34）。永久性微球组报告了局灶性无症状骨坏死，提示需影像学监测。
要点
- GAE组内VAS疼痛评分显著降低，但假手术对照RCT未显示组间获益，不能确立因果疗效。
- 永久性微球与临时性栓塞剂（伊米配能/西司他丁）的疼痛结局无显著差异。
- 局灶性无症状骨坏死仅见于永久性微球组，建议前瞻性影像监测并充分告知患者。
英文原文（摘要）· 点击展开
PURPOSE: To systematically describe the observed safety and pain outcomes of genicular artery embolization (GAE) for symptomatic knee osteoarthritis (KOA), compare embolic agent classes, and critically appraise the methodological quality of available evidence, including sham-controlled randomized controlled trial (RCT) design.
METHODS: Adults with radiographic KOA who underwent transcatheter GAE and reported ≥ 1 patient-reported outcome measure were eligible. The primary outcome was VAS pain reduction at 12 months. Secondary outcomes included WOMAC and KOOS scores, technical success, and adverse events. Random-effects meta-analysis with REML estimation was used; prediction intervals were computed. Pre-specified subgroup analysis compared imipenem/cilastatin versus permanent microspheres.
RESULTS: 22 studies (3 RCTs, 19 single-arm or comparative cohorts) comprising 633 patients and 719 knees were included. Pooled within-group VAS WMD at 12 months: -39.6 mm (95% CI, -47.1 to - 32.1; 95% prediction interval [PI], -58.4 to - 20.8; I2 = 76%; p < 0.001). IPM/CS and permanent microspheres produced equivalent observed outcomes (between-subgroup p = 0.73). Technical success: 98.7%. Pooled minor adverse event rate: 18.3%. RCT-pooled between-group SMD versus sham: -0.23 (95% CI, -0.71 to + 0.25; p = 0.34; I2 = 38%).
CONCLUSIONS: GAE is consistently associated with large within-group pain reductions; however, these pre-post estimates are descriptive and do not establish procedure-specific causal efficacy. Three sham-controlled RCTs did not demonstrate significant between-group benefit, representing the highest-quality evidence currently available. Embolic agent class does not significantly influence pain-reduction outcomes; however, safety profiles are not equivalent-focal asymptomatic osteonecrosis was reported exclusively with permanent microspheres, warranting prospective imaging surveillance and explicit patient counseling. Adequately powered RCTs with pharmacologically inert controls, standardized technique protocols, and systematic safety imaging are required before definitive conclusions can be drawn.
引用
- Lanza E, Poretti D, Pedicini V, et al. Permanent vs. Temporary embolic agents in genicular artery embolization for knee Osteoarthritis: A systematic review and Meta-Analysis. Eur J Radiol. 2026. PMID: 42208168. doi:10.1016/j.ejrad.2026.112968
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。